Response to Thompson and Moore

To the Editor:

We want to thank Drs. Thompson and Moore for their thoughtful input to our recent review article “Racial/ethnic differences in traumatic brain injury: pathophysiology, outcomes, and future directions.” ^1,2 We appreciate the time they took to articulate their concerns and the depth of analysis they provided. Their feedback offers valuable insights and highlights critical aspects we must consider in future research.

Firstly, their point regarding the potential reinforcement of the concept of biological race is well taken. We agree that the construct of race is social rather than biological, and our intention was not to conflate the two. However, based on their comments, we acknowledge that our approach may have inadvertently given that impression. Going forward, we will strive to be more explicit in differentiating between races as a social determinant of health and biological factors. To clarify, our goal was to review and summarize the current state of understanding on how various racial/ethnic groups exhibit potentially different pathophysiological responses to traumatic brain injury (TBI) and not explore the biological basis of race/ethnicity and its implication on TBI. ¹ Although the health differences between racial and ethnic groups are not caused by genetics, we believe further research on other biological/genetic risk factors will be required to understand and mitigate racial/ethnic disparities in traumatic brain injury.

Their critique of the binary comparison approach and the over-reliance on administrative data is also well received. We recognize the limitations of this methodology and its potential to oversimplify complex issues. Future research will benefit from a more nuanced approach that acknowledges diversity within racial/ethnic groups and employs more robust data sources.

Moreover, their emphasis on the need to address structural racism and inequities in healthcare resonates deeply with us. We acknowledge that our review could have been more comprehensive in addressing these factors. Our future work will aim to integrate a critical examination of these systemic issues and their impact on health outcomes.

In conclusion, the letter from Thompson and Moore has provided valuable feedback that will undoubtedly enrich our readership’s understanding and approach to this complex subject. Our goal was to understand how TBI pathobiology and outcome are different in various racial/ethnic groups, and not the biology of race/ethnicity and how that influences TBI outcome. We, along with many of our colleagues in this field, are committed to advancing TBI research in a manner that is both scientifically rigorous and socially responsible.